Everything you should know about tendonitis (tendinitis)

Tendonitis, also known as tendinitis, is a condition where you have an inflammatory reaction in a tendon. The diagnosis can usually be treated conservatively with relief, physical therapy and adapted rehabilitation exercises.

Some well-known forms of tendinitis include Achilles tendinitis (tendinitis of the Achilles tendon), trochanter tendinitis (tendonitis on the outside of the hip) and patellar tendinitis (jumper's knee). Often, the term tendinitis is incorrectly used in many cases where it is actually a matter of tendon damage (tendinosis), which occurs far more often than an inflammation of the tendon.

- Tendon damage and tendinitis are not the same

It is important to distinguish between tendinitis and tendon damage, as the two have similar symptoms, but different treatment. At our clinic departments at the Vondtklinikkene - interdisciplinary health, this is a diagnosis we investigate, treat and rehabilitate on an almost daily basis. A common occurrence is that many people let the diagnosis get worse and worse before they actually deal with the problem. A classic is that you have tried several "anti-inflammatory cures" without effect. This can actually lead to impaired tendon health if there is an overuse injury (we take a closer look at the evidence around this a little further down).

"The article has been written in collaboration with, and quality checked by, publicly authorized health personnel. This includes both physiotherapists and chiropractors at Pain clinics Interdisciplinary Health (see clinic overview here). We always recommend having your pain assessed by knowledgeable healthcare personnel."

Tips: Scroll down to the bottom of the article to see a video with exercises against tendinitis in the shoulder. Our YouTube channel also contains a number of other, free exercise programs against tendinitis in other parts of the body - including the hips.

- Is it really tendonitis?

The word tendonitis is a word that is used too often. At least if we are to listen to the research. Several studies point to the fact that most tendinitis are actually non-inflammatory overuse injuries (tendinosis).¹ This is addressed, among other things, in "Time to abandon the tendinitis myth» published in the recognized research journal British Medical Journal. Here, the researchers describe why this is a bigger problem than it might first sound like. Potentially, it can lead to tendon injuries not healing and becoming chronic.

- Anti-inflammatory drugs can be counterproductive

Recommending an 'anti-inflammatory regimen' is a no-brainer for the vast majority of clinicians when it comes to tendon complaints, but what many are not aware of is that incorrect use can lead to weak tendon fibers and an increased risk of tears. In addition, it can cause more serious side effects such as heart and kidney disease. A quote from the above study:

"Physicians should acknowledge that painful overuse tendon conditions have a non-inflammatory pathology" (Khan et al, British medical journal)

Translated from English, this means that clinicians must recognize that the research shows that painful overuse injuries to the tendons do not have an inflammatory process. This means that, in the majority of tendon complaints, there are no signs of inflammatory reactions. There are a number of studies that show that adding anti-inflammatory drugs, when there is no inflammation, can have a direct negative effect. NSAIDS can be translated into Norwegian as non-steroidal anti-inflammatory drugs. Among other things, it has been documented that NSAIDS can lead to:

• Ulcer

• High blood pressure

• Heart disease

• Kidney disease

• Worsening of known heart condition

These are five of the possible side effects mentioned in the study "Nonsteroidal anti-inflammatory drugs: adverse effects and their prevention" which was published in the journal «Seminars in arthritis and rheumatism».² To limit the risk, it is important to limit both the amount and duration when taking anti-inflammatory drugs.

- NSAIDS can reduce muscle growth and tendon repair

Here we come to another interesting topic. This is because non-steroidal anti-inflammatory drugs can also interfere with the normal repair of tendon fibers and muscle fibers. Among other things, it has been documented that:

• Ibuprofen (ibux) prevents muscle growth ³

• Ibuprofen delays bone healing ⁴

• Ibuprofen delays tendon repair ⁵

• Diclofenac (Voltaren) reduces the content of macrophages (essential for senile healing) ⁶

As you can see, there is no shortage of research showing that unnecessary the use of anti-inflammatory drugs can be very negative. For example, let's consider a common scenario where a person regularly applies voltarol ointment, but does not actually have an inflammation in the area in question. In light of the above studies, this will then reduce the content of macrophages. These are a type of white blood cells that are an active part of the immune system. They work by eating up bacteria, damaged and destroyed cells, as well as other particles that shouldn't be there.

"Macrophages contribute to tendon repair and are also anti-inflammatory. Diclofenac can therefore work against its purpose if it reduces the content of these white blood cells - and in this way prolongs the duration and severity of tendon damage."

What is tendonitis?

Now we have talked a lot about the fact that tendinitis is probably misdiagnosed - and that they are actually tendon injuries. But it's not like they never occur. Inflammation in the tendon occurs due to micro tears. This most often happens when the tendon is overloaded by a sudden and powerful stretching mechanism.

- When a tendinitis is actually a tendon injury

Tennis elbow is a diagnosis that is regularly, even in 2024, referred to as one 'tendonitis of the extensor carpi radialis brevis'. But research has documented, beyond any doubt, that tennis elbow does not have inflammatory processes.⁷ It is a tendon injury - not a tendonitis. Yet this condition is regularly (and incorrectly) treated with anti-inflammatory drugs. Something we have learned earlier in the article that will work against its purpose.

Pain clinics: Please contact us if you have any questions

Our clinic departments at Vondtklinikkene (click here for a complete overview of our clinics), including in Oslo (Lambert seats) and Akershus (Eidsvoll Sound og Raw wood), has a distinctively high professional competence in the investigation, treatment and rehabilitation of pain in muscles, tendons, nerves and joints. Toe contact us if you want help from publicly authorized therapists with expertise in these fields.

Treatment of tendinitis and tendon damage

As you have gained good insight into, it is absolutely essential that one investigates and assesses whether it is a matter of tendinitis or tendinosis. Where the pain is located can provide information on whether it is tendinitis or tendon damage. For example, it has been documented that all tennis elbows are tendon injuries (not tendonitis).⁷

- Rest and relief are important for both diagnoses

Something we can agree on is that rest and stress management are important for both types of tendon problems (tendinopathy). This may include the use of compression supports og cooling with cold pack. Self-massage can also be used for symptom relief arnica gel towards the painful area as applicable. All links open in a new browser window.

Tips: Knee support

Relieving tendonitis and tendon injuries for a period can be beneficial. This gives the area peace and the opportunity to repair itself. Here you see an example of a knee support that can be used for tendinitis or tendon damage in the knee. Press the image or here to read more about it.

Cortisone injection for tendinitis?

Cortisone is a strong agent with a number of possible side effects. Among other things, it is well documented that a cortisone injection will stop natural collagen repair, which in turn gives a significantly higher risk of tendon tears in the future. Recent research published in Journal of orthopedic and sports physical therapy believes that cortisone injections against tendon problems (tendinopathy) should be stopped.⁸

- Poorer results in the long term and increased risk of tendon tears

In the study with the name "Terminating corticosteroid injection in tendinopathy?" they show that treatment with cortisone injection leads to worse long-term results than without. They also point to the risk of damaging the tendon and causing a tendon tear. On this basis, they believe that cortisone injection should not be used against tendons at all. Furthermore, they also write that physical therapy and rehabilitation exercises should be recommended.

Physical treatment of tendinitis and tendon injuries

There are several physical treatment techniques that can be beneficial in the treatment of both tendinitis and tendinosis. But the way it works will be a little different. These treatment methods include, among others:

• Deep friction massage

• Myofascial treatment

• Tendon Tissue Treatment (IASTM)

• Trigger point therapy

• Shockwave Therapy

• Dry needle

Muscular and physical techniques stimulate circulation and cell activity. In the case of tendinitis, in-depth treatment techniques will be able to break down myofascial restrictions, scar tissue and stimulate repair - after the inflammation has subsided. When working against tendon damage, treatment can lead to increased collagen production and faster healing. By dissolving myofascial tension and lengthening the muscle fibers, you will also reduce the tensile load on the tendon.

Treatment of tendinitis (tendinitis)

• healing time: Approximately 6-18 weeks. The degree of severity and initiation of treatment play key roles.
• purpose: Reduce inflammation. Stimulate natural repair.
• Tiltak: Relief, cooling and any anti-inflammatory drugs. Physical treatment and rehabilitation exercises when the acute inflammation has subsided.

Treatment of tendon tissue may take time

It is important to note that physical treatment and rehabilitation of tendons often takes time. This is, among other things, because tendon tissue does not have the same repair rate as muscle tissue. So here it is important to bend your neck and listen to your physiotherapist or chiropractor. You will receive concrete rehabilitation exercises that you will start with from an early phase.

How is tendonitis (tendinitis) diagnosed?

First, clinicians will go through a history taking and hear more about your symptoms and pain. You then move on to a clinical and functional examination - where the therapist will, among other things, examine:

• Muscle function

• Tendon function

• Painful areas

• Range of motion in joints

• Nerve tension tests

If medically indicated, or if one does not respond as desired to the treatment, it may be appropriate to refer to diagnostic imaging. Chiropractors, like doctors, have the right to refer to both MRI examinations and other diagnostic imaging.

MRI examination of tendinitis in the Achilles

As mentioned, the majority of cases will not need to be referred for an MRI examination. But if the functional examination gives indications of suspicion of tear-off, or similar, it may be relevant.

• Picture 1: Here we see a normal Achilles tendon.
• Picture 2: A torn Achilles tendon - and we also see how an inflammatory process has arisen with fluid accumulation in the area. This forms the basis for the diagnosis of Achilles rupture with associated tendinitis (inflammation of the tendon).

Training and exercises against tendinitis

Earlier in the article, we wrote how relief and rest are important aids when it comes to the healing of tendinitis and tendon injuries. But it is also important to note that this does not mean that you should 'stop completely'. Here, it is important to combine different techniques and training to reach the goal. This may, among other things, include:

• Relief

• Ergonomic measures

• Support (for example, compression supports)

• stretching Exercises

• Cooling (to reduce swelling)

• Eccentric exercise

• Adapted strength exercises (often with bands)

• Diet

• Physical treatment

But let's take a closer look at adapted training for tendinitis (tendinitis).

Stretching exercises against tendinitis

Light mobility exercises and stretching exercises will stimulate microcirculation in the area. In addition, it will also help to maintain the length of both tendon fibers and muscle fibers. This will also help to maintain mobility, while at the same time stimulating repair processes.

Adapted strength training against tendinitis

Eccentric training and strength training with rubber bands are two types of adapted strength training that are suitable for tendinitis. Here it is very common to use elastic pilates band (also called yoga bands) and minibands. In the video below, you can see an example of such a training program.

Our recommendation: Pilates band (150 cm)

VIDEO: 5 stretching exercises against tendinitis in the shoulder

In the video below shows chiropractor Alexander Andorff presented five adapted exercises that are suitable for tendinitis in the shoulder. The exercises can be done every other day (3-4 times a week). Adapt the number of repetitions based on your own health situation. We regularly receive questions about which knit it is - and it is one pilates band (150 cm). All links to training equipment and the like open in a new browser window.

Feel free to subscribe for free on our youtube channel (The link opens in a new browser window) for more free training programs (including programs against other types of tendinitis). And remember that we are always available for questions and input.

The pain clinics: Your choice for modern treatment

Our clinicians and clinic departments always aim to be among the elite in the investigation, treatment and rehabilitation of pain and injuries in muscles, tendons, nerves and joints. By pressing the button below, you can see an overview of our clinics - including in Oslo (incl Lambert seats) and Akershus (Raw wood og Eidsvoll Sound). Feel free to contact us if you have any questions or are wondering about anything.

See clinic overview

Article: Everything you should know about tendonitis (tendinitis)

Written by: Our publicly authorized chiropractors and physiotherapists at Vondtklinikkene

Fact check: Our articles are always based on serious sources, research studies and research journals - such as PubMed and the Cochrane Library. Please contact us if you spot any errors or have comments.

Research and sources

1. Khan et al, 2002. Time to abandon the “tendinitis” myth. Painful, overuse tendon conditions have a non-inflammatory pathology. BMJ 2002;324:626.

2. Vonkeman et al, 2008. Nonsteroidal anti-inflammatory drugs: adverse effects and their prevention. Semin Arthritis Rheum. 2010 Feb;39(4):294-312.

3. Lilja et al, 2018. High doses of anti-inflammatory drugs compromise muscle strength and hypertrophic adaptations to resistance training in young adults. Acta Physiol (Oxf). 2018 Feb;222(2).

4. Aliuskevicius et al, 2021. The Influence of Ibuprofen on the Healing of Nonsurgically Treated Colles' Fractures. Orthopedics. 2021 Mar-Apr;44(2):105-110.

5. Connizzo et al, 2014. The detrimental effects of systemic Ibuprofen delivery on tendon healing are time-dependent. Clin Orthop Relat Res. 2014 Aug;472(8):2433-9.

6. Sunwoo et al, 2020. The role of the macrophage in tendinopathy and tendon healing. J Orthop Res. 2020; 38: 1666–1675.

7. Bass et al, 2012. Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters. Int J Ther Massage Bodywork. 2012; 5(1): 14–17.

8. Visser et al, 2023. Terminating Corticosteroid Injection in Tendinopathy? J Orthop Sports Phys Ther. 2023 Nov;54(1):1-4.

- Feel free to follow the Vondtklinikkene Verrrfaglig Helse at YOUTUBE

- Feel free to follow the Vondtklinikkene Verrrfaglig Helse at FACEBOOK